Recurrent laryngeal papillomatosis

Abstract

Human papillomaviruses (HPV)6 and11 cause 90% of recurrent laryngeal papillomatosis (RLP). It is unclear whether recurrences are caused by new infections or the spread of infected cells. Symptomatic and sometimes curative treatment is laser surgery or conventional microsurgical removal. RLP surgery aims to relieve shortness of breath and improve the voice. Patients (especially children) are affected by voice problems, repetitive surgeries, pulmonary manifestations, and psychological trauma. Vaccination with Gardasil9 (Merck & Co., Rahway, NJ, USA) prevents new infections with HPV6, 11, 16, 18, 31, 33, 45, 52, and58 and induces vaccine antigen-specific antibodies and CD4+ Thelper cells. According to current studies, RLP can be avoided with prophylactic vaccination. The treatment is associated with ageneral vaccination risk (European Medicines Agency approval: girls and boys from 9years). Studies also show that the vaccine after removal of HPV-associated neoplasia/papilloma prevents recurrences. Extension of the vaccination recommendation to prevent recurrences of HPV-associated diseases in men may promote applicability and herd immunity. For rare and treatment-refractory cases with laryngotracheal involvement, systemic therapy with bevacizumab (e.g. Avastin; Genentech, San Francisco, CA, USA), aVEGF antibody, is apromising adjuvant treatment option.